中华肝脏外科手术学电子杂志
中華肝髒外科手術學電子雜誌
중화간장외과수술학전자잡지
CHINESE JOURNAL OF HEPATIC SURGERY(ELECTRONIC EDITION)
2014年
2期
79-83
,共5页
黄利利%郑鹏飞%毛杰%李凡%郑永光%程志斌
黃利利%鄭鵬飛%毛傑%李凡%鄭永光%程誌斌
황리리%정붕비%모걸%리범%정영광%정지빈
体层摄影术,螺旋计算机%血管造影术%成像,三维%癌,肝细胞%肝切除术
體層攝影術,螺鏇計算機%血管造影術%成像,三維%癌,肝細胞%肝切除術
체층섭영술,라선계산궤%혈관조영술%성상,삼유%암,간세포%간절제술
Tomography,spiral computed%Angiography%Imaging,three-dimensional%Carcinoma,hepatocellular%Hepatectomy
目的：探讨三维手术规划系统在原发性肝癌（肝癌）切除术前评估中的应用价值。方法本前瞻性研究对象为2012年6月至2013年6月在兰州大学第二医院普通外科收治的44例肝癌患者。所有患者均签署知情同意书，符合医学伦理学规定。其中男32例，女12例，平均年龄（60±12）岁。按照随机数字表法将患者随机分为计算机体层摄影血管造影术（CTA）组和三维手术规划组，并根据肿瘤大小、累及范围及既往手术史将两组进一步分为复杂肝癌亚组和非复杂肝癌亚组。CTA组的复杂肝癌亚组8例，非复杂肝癌亚组14例；三维手术规划组的复杂肝癌亚组6例，非复杂肝癌亚组16例。CTA组采用CTA对肝癌切除术进行术前评估。三维手术规划组采用肝脏三维手术规划系统对肝癌切除术进行术前评估。以手术所见作为金标准，观察CTA与三维手术规划系统对肝癌、肝癌与周围组织毗邻关系的显示情况，以及对12条腹腔血管、肝动脉变异、肿瘤侵犯血管、胆管扩张的显示率。分析三维手术规划系统预测的肿瘤体积与实际切除肿瘤质量的关系。非正态分布资料采用M（Q25，Q75）表示，两种检查方法的显示率比较采用χ2检验或Fisher确切概率法。三维手术规划系统预测的肿瘤体积与实际切除肿瘤质量的关系分析采用Spearman秩相关分析。结果两种方法均能显示肝癌病灶，三维手术规划系统还能清晰显示肝癌与周围组织的毗邻关系。在复杂肝癌患者中，CTA组对腹腔血管的显示率为81%（78/96），三维手术规划组为100%（72/72），差异有统计学意义（χ2=15.12，P<0.05）。CTA组对胆管扩张均未能显示，三维手术规划组对胆管扩张的显示率为3/6。在非复杂肝癌患者中，CTA组对腹腔血管的显示率为90%（151/168），三维手术规划组为100%（192/192），差异有统计学意义（χ2=20.39，P<0.05）。CTA组对胆管扩张均未能显示，三维手术规划组对胆管扩张的显示率为19%（3/16）。在复杂肝癌患者中，三维手术规划系统预测肿瘤体积的中位数为218（129，429）ml，实际切除肿瘤质量为194（112，429）g，两者呈正相关（r=0.943，P<0.05），平均误差率为6.5%。在非复杂肝癌患者中，三维手术规划系统预测肿瘤体积为368（89，560）ml，实际切除肿瘤质量为395（126，578）g，两者呈正相关（r=0.958，P<0.05），平均误差率为6.3%。结论与CTA相比，三维手术规划系统能更好地显示肿瘤与周围组织的毗邻关系、腹腔血管以及胆管扩张情况，并能较准确地预测肿瘤切除体积，尤其适用于复杂肝癌患者。
目的：探討三維手術規劃繫統在原髮性肝癌（肝癌）切除術前評估中的應用價值。方法本前瞻性研究對象為2012年6月至2013年6月在蘭州大學第二醫院普通外科收治的44例肝癌患者。所有患者均籤署知情同意書，符閤醫學倫理學規定。其中男32例，女12例，平均年齡（60±12）歲。按照隨機數字錶法將患者隨機分為計算機體層攝影血管造影術（CTA）組和三維手術規劃組，併根據腫瘤大小、纍及範圍及既往手術史將兩組進一步分為複雜肝癌亞組和非複雜肝癌亞組。CTA組的複雜肝癌亞組8例，非複雜肝癌亞組14例；三維手術規劃組的複雜肝癌亞組6例，非複雜肝癌亞組16例。CTA組採用CTA對肝癌切除術進行術前評估。三維手術規劃組採用肝髒三維手術規劃繫統對肝癌切除術進行術前評估。以手術所見作為金標準，觀察CTA與三維手術規劃繫統對肝癌、肝癌與週圍組織毗鄰關繫的顯示情況，以及對12條腹腔血管、肝動脈變異、腫瘤侵犯血管、膽管擴張的顯示率。分析三維手術規劃繫統預測的腫瘤體積與實際切除腫瘤質量的關繫。非正態分佈資料採用M（Q25，Q75）錶示，兩種檢查方法的顯示率比較採用χ2檢驗或Fisher確切概率法。三維手術規劃繫統預測的腫瘤體積與實際切除腫瘤質量的關繫分析採用Spearman秩相關分析。結果兩種方法均能顯示肝癌病竈，三維手術規劃繫統還能清晰顯示肝癌與週圍組織的毗鄰關繫。在複雜肝癌患者中，CTA組對腹腔血管的顯示率為81%（78/96），三維手術規劃組為100%（72/72），差異有統計學意義（χ2=15.12，P<0.05）。CTA組對膽管擴張均未能顯示，三維手術規劃組對膽管擴張的顯示率為3/6。在非複雜肝癌患者中，CTA組對腹腔血管的顯示率為90%（151/168），三維手術規劃組為100%（192/192），差異有統計學意義（χ2=20.39，P<0.05）。CTA組對膽管擴張均未能顯示，三維手術規劃組對膽管擴張的顯示率為19%（3/16）。在複雜肝癌患者中，三維手術規劃繫統預測腫瘤體積的中位數為218（129，429）ml，實際切除腫瘤質量為194（112，429）g，兩者呈正相關（r=0.943，P<0.05），平均誤差率為6.5%。在非複雜肝癌患者中，三維手術規劃繫統預測腫瘤體積為368（89，560）ml，實際切除腫瘤質量為395（126，578）g，兩者呈正相關（r=0.958，P<0.05），平均誤差率為6.3%。結論與CTA相比，三維手術規劃繫統能更好地顯示腫瘤與週圍組織的毗鄰關繫、腹腔血管以及膽管擴張情況，併能較準確地預測腫瘤切除體積，尤其適用于複雜肝癌患者。
목적：탐토삼유수술규화계통재원발성간암（간암）절제술전평고중적응용개치。방법본전첨성연구대상위2012년6월지2013년6월재란주대학제이의원보통외과수치적44례간암환자。소유환자균첨서지정동의서，부합의학윤리학규정。기중남32례，녀12례，평균년령（60±12）세。안조수궤수자표법장환자수궤분위계산궤체층섭영혈관조영술（CTA）조화삼유수술규화조，병근거종류대소、루급범위급기왕수술사장량조진일보분위복잡간암아조화비복잡간암아조。CTA조적복잡간암아조8례，비복잡간암아조14례；삼유수술규화조적복잡간암아조6례，비복잡간암아조16례。CTA조채용CTA대간암절제술진행술전평고。삼유수술규화조채용간장삼유수술규화계통대간암절제술진행술전평고。이수술소견작위금표준，관찰CTA여삼유수술규화계통대간암、간암여주위조직비린관계적현시정황，이급대12조복강혈관、간동맥변이、종류침범혈관、담관확장적현시솔。분석삼유수술규화계통예측적종류체적여실제절제종류질량적관계。비정태분포자료채용M（Q25，Q75）표시，량충검사방법적현시솔비교채용χ2검험혹Fisher학절개솔법。삼유수술규화계통예측적종류체적여실제절제종류질량적관계분석채용Spearman질상관분석。결과량충방법균능현시간암병조，삼유수술규화계통환능청석현시간암여주위조직적비린관계。재복잡간암환자중，CTA조대복강혈관적현시솔위81%（78/96），삼유수술규화조위100%（72/72），차이유통계학의의（χ2=15.12，P<0.05）。CTA조대담관확장균미능현시，삼유수술규화조대담관확장적현시솔위3/6。재비복잡간암환자중，CTA조대복강혈관적현시솔위90%（151/168），삼유수술규화조위100%（192/192），차이유통계학의의（χ2=20.39，P<0.05）。CTA조대담관확장균미능현시，삼유수술규화조대담관확장적현시솔위19%（3/16）。재복잡간암환자중，삼유수술규화계통예측종류체적적중위수위218（129，429）ml，실제절제종류질량위194（112，429）g，량자정정상관（r=0.943，P<0.05），평균오차솔위6.5%。재비복잡간암환자중，삼유수술규화계통예측종류체적위368（89，560）ml，실제절제종류질량위395（126，578）g，량자정정상관（r=0.958，P<0.05），평균오차솔위6.3%。결론여CTA상비，삼유수술규화계통능경호지현시종류여주위조직적비린관계、복강혈관이급담관확장정황，병능교준학지예측종류절제체적，우기괄용우복잡간암환자。
Objective To investigate the application value of three-dimensional surgery planning system in the preoperative evaluation of primary liver cancer (PLC) resection. Methods A total of 44 patients with PLC [32 males and 12 females, mean age of (60±12) years old] in Department of General Surgery, Lanzhou University Second Hospital from June 2012 to June 2013 were enrolled in this prospective study. The informed consents of all patients were obtained and the ethics committee approval was received. According to random number table method, the patients were randomly divided into 2 groups: computed tomography angiography (CTA) group and three-dimensional surgery planning (3D) group. Subgroups of complex PLC and non-complex PLC were further defined in each group according to tumor size, tumor invasive extent and history of surgery. In CTA group, 8 cases was assigned in complex PLC subgroup and 14 cases in non-complex PLC subgroup, and 6, 16 cases respectively in 3D group. CTA was used in the preoperative evaluation of PLC resection in CTA group. Liver three-dimensional surgery planning system was used in the preoperative evaluation of PLC resection in 3D group. The intra-operative finding was taken as a gold standard. The visualization of PLC, the adjacent relationship between PLC and peripheral tissues, the display rates of 12 abdominal vessels, variation of hepatic artery, vascular invasion of tumor, cholangiectasis by CTA and three-dimensional surgery planning system were observed. The relationship between estimated tumor volume by three-dimensional surgery planning system and actual weights of resected tumor was analyzed. Non-normal distribution data were expressed in M(Q25,Q75). The display rates by 2 methods were compared using Chi-square or Fisher's exact probability test. The relationship between estimated tumor volume by three-dimensional surgery planning system and actual weights of resected tumor was analyzed using Spearman rank correlation analysis. Results PLC lesions could be both visualized by 2 methods. The adjacent relationship between PLC and peripheral tissues could also be clearly visualized by three-dimensional surgery planning system. For patients with complex PLC, the display rate of abdominal vessels was 81%(78/96) in CTA group, and was 100%(72/72) in 3D group, where significant difference was observed (χ2=15.1, P<0.05). Cholangiectasis could not be visualized in CTA group and the display rate of cholangiectasis was 3/6 in 3D group. For patients with non-complex PLC, the display rate of abdominal vessels was 90%(151/168) in CTA group, and was 100%(192/192) in 3D group, where signiifcant difference was observed (χ2=20.39, P<0.05). Cholangiectasis could not be visualized in CTA group and the display rate of cholangiectasis was 19%(3/16) in 3D group. For patients with complex PLC, the median estimated tumor volume by three-dimensional surgery planning system was 218(129,429)ml and the actual weights of resected tumor was 194(112,429)g, where positive correlation was observed (r=0.943, P<0.05) with an average error rate of 6.5%. For patients with non-complex PLC, the estimated tumor volume by three-dimensional surgery planning system was 368(89,560)ml and the actual weights of resected tumor was 395(126,578)g, where positive correlation was observed (r =0.958, P<0.05) with an average error rate of 6.3%. Conclusions Compared with CTA, three-dimensional surgery planning system can better display the adjacent relationship between tumor and peripheral tissues, abdominal vessels, cholangiectasis and estimate the volume of resected tumor more accurately. It is especially suitable for patients with complex liver cancer.
